Citation Nr: 20006003 Decision Date: 01/24/20 Archive Date: 01/23/20 DOCKET NO. 15-34 289 DATE: January 24, 2020 ORDER Entitlement to an increased evaluation for a back disability, currently rated as 40 percent disabling is denied. Entitlement to an increased evaluation for radiculopathy of the left lower extremity, currently rated as 10 percent disabling is denied. Entitlement to an increased evaluation for radiculopathy of the right lower extremity, currently rated as 10 percent disabling is denied. Entitlement to an increased evaluation for a heart disability, currently rated as noncompensable is denied. Entitlement to service connection for tinnitus is denied. FINDINGS OF FACT 1. At no time during the relevant appeal period did the Veteran’s back disability cause him to have unfavorable ankylosis of the entire thoracolumbar spine. 2. At no time during the relevant appeal period did the Veteran’s radiculopathy of the left lower extremity cause him to have moderate incomplete paralysis of the sciatic nerve. 3. At no time during the relevant appeal period did the Veteran’s radiculopathy of the right lower extremity cause him to have moderate incomplete paralysis of the sciatic nerve. 4. At no time during the relevant appeal period did the Veteran’s heart disability cause him to have permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor. 5. The evidence of record does not establish a nexus between an in-service event and the Veteran’s tinnitus. CONCLUSIONS OF LAW 1. The criteria for entitlement to an increased evaluation for a back disability, currently rated as 40 percent disabling have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, Diagnostic Code 5237. 2. The criteria for entitlement to an increased evaluation for radiculopathy of the left lower extremity, currently rated as 10 percent disabling, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, Diagnostic Code 8520. 3. The criteria for entitlement to an increased evaluation for radiculopathy of the right lower extremity, currently rated as 10 percent disabling, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, Diagnostic Code 8520. 4. The criteria for entitlement to an increased evaluation for a heart disability, currently rated as noncompensable have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.21, 4.104, Diagnostic Code 7010. 5. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. § 1110, 1154, 5107; 38 C.F.R. § 3.303; 38 C.F.R. § 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from April 2003 to July 2006. This appeal comes to the Board of Veterans’ Appeals (Board) from a rating decision, dated September 2013, issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Des Moines, Iowa (hereinafter Agency of Original Jurisdiction (AOJ)). In its decision, the RO granted service connection for disc compression L3-4 (claimed as degenerative disc disease) with an evaluation of 40 percent effective April 18, 2012. The RO also granted service connection for right and left lower extremity radiculopathy with an evaluation of 10 percent effective April 18, 2012. The RO denied service connection for tinnitus because this condition neither occurred in nor was caused by service. Increased Ratings A disability rating is determined by applying VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. If there is a question as to which evaluation to apply to the Veteran’s disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and coordination of rating with impairment of function. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of his disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). The Board must also assess the competence and credibility of lay statements and testimony. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). In increased rating claims, a Veteran’s lay statements alone, absent a negative credibility determination, may constitute competent evidence of worsening, at least with respect to observable symptoms. See Vazquez-Flores v. Shinseki, 24 Vet. App. 94, 102 (2010), rev’d on other grounds by Vazquez-Flores v. Shinseki, 580 F.3d 1270, 1277 (Fed. Cir. 2009). 1. Entitlement to an increased evaluation for a back disability, currently rated as 40 percent disabling The Veteran’s lumbar strain is currently rated as 40 percent disabling under Diagnostic Code 5237. The Veteran seeks a higher rating. Under the General Rating Formula for Diseases and Injuries of the Spine, degenerative arthritis of the spine with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease: A 10 percent rating contemplates forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent of more of height. A 20 percent rating contemplates forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating contemplates unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation will be assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating requires unfavorable ankylosis of the entire spine. When an evaluation of a disability is based on limitation of motion, the Board must also consider, in conjunction with the otherwise applicable diagnostic code, any additional functional loss the Veteran may have sustained by virtue of other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy of disuse. The provisions of 38 C.F.R. § 4.40 state that disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). The Board observes that 38 C.F.R. § 3.471a allows for the assignment of disability evaluation based on the presences of symptoms of intervertebral disc syndrome (IVDS) under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. While the Veteran reported pain and numbness that radiated from his back into his lower extremities, the record does not reflect that the Veteran’s service-connected lumbar disability is manifested by IVDS. On the contrary, the report of VA examination conducted in June 2012 noted that the Veteran did not have IVDS of the thoracolumbar spine. Accordingly, a rating based on IVDS with incapacitating episodes is not applicable. Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of “the normal working movements of the body,” such as “excursion, strength, speed, coordination, and endurance,” in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011) (quoting 38 C.F.R. § 4.40). With any form of arthritis, painful motion is an important factor of disability. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. Special note should be taken of objective indications of pain on pressure or manipulation, muscle spasm, crepitation, and active and passive range of motion of both the damaged joint and the opposite undamaged joint. 38 C.F.R. § 4.59. Moreover, the Court has held that the application of 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. When § 4.59 is raised by the claimant or reasonably raised by the record, even in non-arthritis contexts, VA should address its applicability. Burton v. Shinseki, 25 Vet. App. 1, 3-5 (2011). The evidence of record is supportive of a 40 percent rating, but no higher, for the Veteran’s back disability. 38 C.F.R. § 4.7. This 40 percent rating is effective for orthopedic manifestations of his thoracolumbar spine disability under Diagnostic Code 5237 under the General Rating Formula for Diseases and Injuries of the Spine. However, the Board concludes that the Veteran is not entitled to an increased disability rating in excess of 40 percent for his service-connected disc compress L3-4 (claimed as degenerative disc disease), at any time during the course of the appeal. 38 C.F.R. § 4.7. In making this determination, the Board has considered the competent and credible medical and lay evidence of record. A June 2013 MRI showed no stenosis and no nerve involvement. He had epidural injections without any significant relief in pain. The records showed referral for consultation for surgery and X-rays showing degenerative disc disease L4-5 with moderate disc herniation with extrusion on the right side and same on the left side L3-4. With regard to orthopedic manifestations of the thoracolumbar spine with consideration of functional loss, the evidence of record does not reveal unfavorable ankylosis of the entire spine warranting a higher 100 percent evaluation, or unfavorable ankylosis of the entire thoracolumbar spine warranting a higher 50 percent evaluation. 38 C.F.R. § 4.71a. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, surgical procedure.” Lewis v. Derwinski, 3 Vet. App. 259 (1992) (citing Saunders Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health at 68 (4th ed. 1987)); Dinsay v. Brown, 9 Vet. App. 79, 81 (1996) (Ankylosis is “stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint,” citing Stedman’s Medical Dictionary 87 (25th ed. 1990)). There is no diagnosis of ankylosis of the thoracolumbar spine in the evidence of record and range of motion findings, although limited at times, are not equivalent to favorable or unfavorable ankylosis. The June 2012 VA spine examinations contain no findings of ankylosis. In addition, VA treatment records and private treatment records document low back pain but fail to reveal any evidence of thoracolumbar spine ankylosis. The Board has considered the Veteran’s need to use a wheelchair and cane and other functional impairments that he exhibits. Nonetheless, it is apparent from the evidence of record that the Veteran’s thoracolumbar spine is not fixated or immobile with fibrous or bony union. With regard to functional loss, as discussed above, the Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca and Mitchell. VA and private treatment records document thoracolumbar pain, but fail to reveal any evidence of thoracolumbar spine ankylosis. Furthermore, the Veteran’s lay statements and testimony do not indicate that there has been ankylosis or lack of range of motion that more nearly approximates ankylosis. It is apparent from the evidence of record that the Veteran’s thoracolumbar spine is not fixated or immobile with fibrous or bony union. Therefore, an increased evaluation above 40 percent for the Veteran’s service-connected thoracolumbar spine disability is not warranted on the basis of functional loss due to pain or weakness or weakened movement or excess fatigability or incoordination in this case, as the Veteran’s symptoms are supported by pathology consistent with the assigned 40 percent rating, and no higher. VA examination dated in June 2012, reveal factors of functional loss such as less movement than normal, incoordination, impaired ability to execute skilled movements smoothly, and instability of station. He uses a cane and wheelchair. The Veteran reported that he experienced a sharp stabbing, lightening, fullness, and swelling sensation. The Board notes it has also considered the competent and credible lay evidence from the Veteran when considering functional loss. Nevertheless, the effect of the pain and other factors listed in the Veteran’s thoracolumbar spine is contemplated in the 40 percent rating assigned. Indeed, as previously discussed, the evidence does not show that pain or other factors cause functional loss more closely approximating unfavorable ankylosis. Once again, pain in itself does not constitute functional loss under VA regulations that evaluate disabilities based upon loss of motion. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim for entitlement to an increased rating for a back disability. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 2. Entitlement to an increased evaluation for radiculopathy of the left and right lower extremities, currently rated as 10 percent disabling Under Diagnostic Code 8520, mild incomplete paralysis of the sciatic nerve, as well as neuritis and neuralgia of that nerve, warrants a 10 percent rating. Moderate incomplete paralysis is assigned a 20 percent rating, and moderately severe incomplete paralysis is warranted for a 40 percent rating. Severe incomplete paralysis of the sciatic nerve with marked muscular atrophy warrants a 60 percent rating. With complete paralysis of the sciatic nerve, which warrants an 80 percent rating, the foot dangles and drops, there is no active movement possible of muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. 38 C.F.R. § 4.124a. Under 38 C.F.R. § 4.124a, a disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, the rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a. In rating peripheral nerve disability, neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. The maximum rating to be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate incomplete paralysis, or with sciatic nerve involvement, for moderately severe incomplete paralysis. 38 C.F.R. § 4.123. Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, can receive a maximum rating of moderate incomplete paralysis, except for tic douloureux or trifacial neuralgia, which may be rated up to complete paralysis. 38 C.F.R. § 4.124. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. Special consideration should be given to any psychotic manifestations, complete or partial loss of use of one or more extremities, speech disturbances, impairment of vision, disturbances of gait, tremors, visceral manifestations, and injury to the skull. 38 C.F.R. § 4.120. The words “slight,” “mild,” “moderate” and “severe” as used in the various diagnostic codes are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. Having reviewed the evidentiary record thoroughly, and resolving all doubt in the Veteran’s favor, the Board does not find any evidence which would warrant the assignment of an evaluation in excess of a 10 percent disability rating. 38 C.F.R. § 4.7. In other words, the medical and lay evidence of record does not establish manifestations consistent with moderate, moderately severe, severe, or complete paralysis radiculopathy of the left or right lower extremities in the sciatic nerve. Rather, the Veteran’s lay statements and the medical evidence of record document that there was no abnormal muscle tone or bulk, no complete paralysis, no organic changes, and no foot drop of the left or right lower extremities. At no point during the pendency of this appeal has the Veteran been observed to exhibit a foot drop or other evidence of complete paralysis. During his June 2012 VA examination, the Veteran was observed to walk with abnormal gait, but with no evidence of a foot drop. The Veteran had an MRI in June 2013 which showed there was no stenosis or nerve root involvement, and there was no numbness/tingling, bladder or bowel changes, nor loss of coordination. An EMG/NCV study was done in February 2015, which indicated findings that were normal for the left sural nerve and left peroneal nerve. There was normal latency of H reflex of both tibial nerves. Left vastus medialis, vastus lateralis, rectus femoris, and gastrocnemius were normal. Muscles supplied by the L4-5 nerve root showed abnormal spontaneous potentials, with relatively normal motor units. The impression was abnormal, and the EMG study was consistent with very early left lumbar radiculopathy, L4-5 roots involvement. As for the Veteran’s subjective reports of symptoms and limitations, the Board finds they are more consistent with a “mild” level of disability. During the June 2012 VA examination, the Veteran stated he is wheelchair bound due to his lumbar back disability except for limited ability to walk with a cane for a distance of 20 feet. Overall, the Board finds these statements are most consistent with a mild level of severity with regards to his radiculopathy claims and do not more nearly approximate a moderate level of severity. Accordingly, the Board concludes that the award of an increased 20 percent disability evaluation for the Veteran’s radiculopathy of the left and right lower extremities is not appropriate during the appeal period. 38 C.F.R. § 4.3. As the Veteran’s overall level of disability remained fairly consistent throughout this period, there is no basis to stage the Veteran’s disability rating. Fenderson, 12 Vet. App. at 126. 3. Entitlement to an increased evaluation for a heart disability, currently rated as noncompensable Under Diagnostic Code 7010, a 10 percent rating is assigned for supraventricular arrhythmias manifested by permanent atrial fibrillation (lone atrial fibrillation), or one to four episodes per year of paroxysmal atrial fibrillation, or other supraventricular tachycardia documented by ECG or Holter monitor. 38 C.F.R. § 4.104. A 30 percent rating is assigned for paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by an electrocardiogram (“ECG”) or Holter monitor. An evaluation in excess of 30 percent is not available under Diagnostic Code 7010. Based upon a review of the longitudinal medical records, and with consideration of the Veteran’s lay symptomatology, the Board finds the Veteran is entitled to a noncompensable rating for his service-connected supraventricular arrhythmia disability and no higher. The Board finds that the Veteran’s medical records document a history of supraventricular arrhythmias, with no reported episodes of atrial fibrillation since 2010. Continuous medication was not taken or needed for this condition. While the Veteran reported episodes of atrial fibrillation and supraventricular tachycardia every month or two, a review of the Veteran’s treatment records shows no report of any episodes since 2010. The last time the Veteran was seen urgently for this condition was in West Valley several years prior. Physical examination revealed normal cardia examination and heart rate of a regular rhythm. The last echocardiogram showed normal findings and an exercise stress test was also normal with indication that had no symptoms with any level of physical activity. The Board emphasizes the July 2013 examination does not suggest permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor as articulated by the 10 percent disability rating. The Board finds no evidence or argument which would suggest the Veteran is entitled to an increased evaluation in excess of a noncompensable rating. The July 2013 VA examination shows that the last and only reported episode of atrial fibrillation was in March 2005. Since his discharge in July 2005, the Veteran continued to have episodes of rapid heart rate and near syncope. The episodes typically did not last very long; however, he felt chest pains at the onset, fatigue, and light-headedness for a large part of the day when the episodes occurred. While the Veteran reported episodes occurred every month or two, approximately eight times within the last year, the notes in CPRS indicated that there had been no episodes since 2010. As such, the Board finds no evidence which would suggest the Veteran experiences permanent atrial fibrillation (lone atrial fibrillation), or; one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor and no basis to award an increased 10 percent evaluation under Diagnostic Code 7010. The Board has considered the applicability of other Diagnostic Codes but concludes the Veteran’s symptoms would not warrant a higher evaluation under any other relevant code. Notably, Diagnostic Code 7011, which pertains to sustained ventricular arrhythmias, is not applicable to the Veteran’s service-connected supraventricular arrhythmias because there have been no evidence or medical opinion which finds the Veteran’s symptoms are sustained. Rather, the evidence of record shows that the Veteran’s arrhythmias are intermittent and rare. Based on this evidence, the Board finds Diagnostic Code 7011 is not applicable to the Veteran’s disability. In addition to considering the applicability of other Diagnostic Codes, the Board has considered the argument advanced by the Veteran and his representative that the Veteran’s overall disability picture more closely approximates the criteria for an increased rating. 38 C.F.R. § 4.7. However, the Board has considered all of the evidence in a light most favorable to the Veteran and finds no evidence which would warrant or suggest an evaluation of 10 percent or higher. As discussed above, the evidence demonstrates that the Veteran’s symptoms have been stable and/or have improved since the episodes of atrial fibrillation in March 2005 and 2010. The overall clinical and lay evidence of record do not support the award of an initial disability rating in excess of a noncompensable disability rating. Therefore, the Board finds the Veteran is not entitled to a compensable evaluation, of 10 percent or greater, for his service-connected supraventricular arrhythmia disability. As discussed above, the medical and lay evidence of record does not indicate that there is any evidence to support an award for an initial disability evaluation in of 10 percent or greater. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service Connection In seeking VA disability compensation, a Veteran generally seeks to establish that a current disability results from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110. “Service connection” basically means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces, or if preexisting such service, was aggravated therein. 38 C.F.R. § 3.303. Establishing service connection generally requires competent evidence showing: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For a claim to be denied on the merits, a preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 4. Entitlement to service connection for tinnitus The Veteran additionally seeks entitlement to service connection for tinnitus. As an initial matter, the Board finds that the Veteran has satisfied the first element of service connection, a current disability of tinnitus. A review of the Veteran’s June 2012 VA audiological examination shows the Veteran has a current diagnosis of tinnitus for VA purposes. See Audiological Examination dated June 2012. Therefore, the Board finds that the Veteran has satisfied the first prong of service connection, the existence of a current disability. 38 U.S.C. §§ 1110, 1131; Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000). As to evidence of an in-service incurrence or aggravation of a disease or injury, the Veteran reported that his tinnitus had an onset date of four years prior to the June 2012 examination. No specific incident triggered his tinnitus. The Veteran worked in tactical aircraft maintenance while he was in the service, causing noise exposure. Therefore, the Board finds that the Veteran has satisfied the second prong of service connection, evidence of an in-service incurrence or aggravation of a disease or injury. 38 U.S.C. §§ 1110, 1131; Boyer, 210 F.3d at 1353. Turning next to evidence of a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the Board finds the weight of the medical evidence does not support a credible nexus. In reaching this determination, the Board finds the medical opinion of the June 2012 VA examiner to be probative and entitled to significant weight. A VA examiner provided an audiological examination in June 2012. The examiner noted that the Veteran’s hearing was within normal limits. Therefore, the VA examiner concluded that the Veteran’s tinnitus was less likely than not a symptom associated with the Veteran’s hearing loss. He also noted that it was less likely than not caused by or a result of military noise exposure. Since there was no documentation of tinnitus in the Veteran’s SMRs and no current hearing loss was present, it appeared less likely than not that the tinnitus was related to in-service noise exposure. Finally, the Board has considered the Veteran’s lay reports of symptoms. While the Veteran is competent as a lay person to report that he experiences tinnitus, his reports of a continuity of tinnitus since service are not credible. While the Veteran has reported during the course of the appeal his tinnitus began while he was in service, his separation examination shows that he did not report any hearing loss or ear trouble upon discharge. The lack of complaints of any ear problem at the time of service discharge and the lack of any diagnosis of any ear disability or neurological disability at the time of his separation examination weigh heavily against a finding that the Veteran’s tinnitus originated during service and has been continuous since service. Further, the Board observes that at his June 2012 audiological examination, the Veteran reported an onset of tinnitus 4 years prior to the examination. This would place the onset of symptoms to approximately 2008 (more than a year following his separation from active duty). This report weighs heavily against an onset of symptoms of tinnitus during, or within one year following, his active military service. The Board finds the contemporaneous medical evidence of record to be more probative than the Veteran’s more recent assertions that tinnitus has continued since service. See Curry v. Brown, 7 Vet. App. 59, 68 (1994) (contemporaneous evidence has greater probative value than history as reported by the veteran). As noted above, a thorough review of the Veteran’s medical records does not show any treatment for, or diagnosis of, tinnitus until years following the Veteran’s separation from active duty service. Therefore, the Board has reviewed all medical and lay evidence, but finds there is no probative evidence of record which establishes that a causal relationship between the Veteran’s tinnitus and an in-service event. Although the Veteran is entitled to the benefit of the doubt where the evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, as here, the preponderance of the evidence is against the claim for service connection. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Bristor The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.